What Causes Depression? Myths About Chemical Imbalances

Every few days I watch Brian Williams for his NBC Nightly News report. I know that this 30-minute program is about more than world events. NBC wants me to think I am clinically depressed, my insides are rotting from cholesterol, and my sexual performance is inadequate. Why? Because each commercial segment is brought courtesy of Cialis, Lipitor, Celebrex, and Cymbalta or another antidepressant drug of the week. Thanks to Lasik surgery (one of the 10 best decisions I've ever made) and intense concentrationhoned by graduate school, the Arial 6 font, rolling list of Cymbalta side effects cannot escape my scrutiny.

Cymbalta no longer appears to be the panacea for first dates and exceptional performance during an eight-hour workday. And the qualities on this list aren't ideal for helping a person break free from the depths of sadness, self-loathing, loss of interest, loneliness, concentration difficulties, fatigue, and suicidal ideations that characterize depressive disorders. Sometimes the so-called cure is worse than the disease.

Instead of challenging your beliefs in this chemical imbalance theory of depression, let me stimulate your curiosity. Let me share a yet to be published study by Dr. Brett Deacon and his colleagues. They recruited 91 adults who are clinically depressed or once was. To make this credible, he gave everyone a fake "Rapid Depression Test" that determined whether their serotonin levels were abnormally low compared to other neurotransmitters. To make this test seem legit, they swiped the inside of people's mouths with a cotton swab and the saliva was carefully moved to a sealed container to be taken to the lab for examination. Afterwards, everyone received detailed test results and a random half of participants were told that their serotonin levels were problematic and there is a clear chemical explanation for their depression. The other half were told their serotonin levels were normal and their depression cannot be purely explained by brain chemistry.

The big question: What happens to people when they buy in to a biomedical explanation for their depression?

The answer: Bad things. They become pessimistic that recovery is possible. They become less confident that they can manage and regulate negative moods that arise (and they always do). The notion that depression is their brain's fault does not lessen the stigma or self-blame one bit. And they no longer believe that psychotherapy is a credible or useful strategy for treating their depression and instead, are ready to be dispensed a pill cure. Essentially, they become less flexible in their options for treating depression and less confident that they will escape its clutches.

It is going to be tough to battle the science fiction promoted by pharmaceutical companies. What makes the challenge increasingly difficult is that these companies spent $57.5 billion to promote drugs in 2004, and the numbers are only getting bigger. If we care about reducing human suffering, it's time to bring on the noise and ensure that everyone knows the science. We are fortunate to have scientists that are willing to fight powerful companies and dominant beliefs in search for the truth.

Thinking that depression is chemically based increases powerlessness and hopelessness and not likely to lead to getting out of the depths. Helen Fisher, for instance, hypothesizes that the problem with taking seratonin is that it also blocks the dopamine receptors, thus making experiential alleviation impossible,
"common sense" might point to the answer to "Where is Love? Where is Hope? Where is a Reason to Live?" Might be the obvious: "Find work you love, someone to love, be valuable to someone, or any combination of the above." This is, of course, not that easy for someone who is depressed, but maybe there is no other answer.
Is there other research that refutes or supports this?

I think the answers you mention are hard for everyone to find, regardless of depression. And part of the value of love, meaningful work, hope, etc is that they open us up to so much discomfort.

There is no research to dispute what you write and people are only starting to bring love and purpose in life into the study and treatment of depression. Good times ahead for research and refined interventions.

My nephew is diagnosed with depression and anxiety. He takes medication to help him cope with his unpleasant, and often at times, impractical state. But I have asked this question before.

Is clear that depression can be linked to by a variety of factors. Loneliness, self-disgust, and inattention are some of the common factors in determining a persons state of mind. Everybody endures a point in their life hardship and a lack of energy. Is normal. But what makes it abnormal if these feelings of emptiness affects your personal well-being, health and relationships. That's when it gets bad. And based on my understanding, my nephews lack of energy was contributed to a lack of chemical balance. Is something I buy, and I do believe some people are so depressed that medication is the only way for them to have healthy relationships. However, I believe physical activity is also a clue.

Teens are impressionable, and fitting in is more of a challenge than trying to make them eat their fruits. If teens find a group or social group that they welcome, odds are they will establish societal relationships within their group. If its a sport they participate in, then the transition will work flawlessly. Recreational activities are few in this day and age of social media, but with the right mind and right approach, and a strong belief system, your social relationships will impact you in a positive way. Is proven that exercising decreases depression and it increases your confidence.

But for some people is not as easy. In the case of my nephew, is very severe. As an uncle is disappointing to hear that my nephew needs medication in order for him to be happy. And these drugs are very potent. That's not my concern. To know that my nephew is living a functional life gives me hope that he will realize the benefits of exercising. I believe this is also a memory issue as well. Not only are there health issues in play, but psychologically, I believe there is more to it. And maybe they'll be hope for those who feel alone and depressed.

Franky, thanks for sharing and I hope your nephew is on the path toward the life he wants, with or without medication as part of the process.

Some of the most interesting research coming out is about evolutionary based treatments for depression that tackle things you mention:
- eating healthy foods
- getting adequate sunlight
- getting substantial exercise
- connecting with other people in ways that allow one to love and increase one's capacity to be loved.

only one clinical trial so far but this is promising. There is no doubt that psychology and psychiatry are fooling themselves by only looking at the neck up.

Excellent article. It's about time the drug companies were taken on by the doctors and psychiatrists who realise that this approach isn't working. Too many keep dishing out the drugs while not believing in them. In fact, a psychiatrist friend told me that he had never cured anyone of anything.

This challenge to the drug sellers is more likely in the UK, where the relationship between medical practitioners and drug companies is not so close as in the US, and there are strict controls on what medications can be advertised to the public. Further, because we have a tax-funded health system, the government is starting to challenge the costs of meds.

Like you I am no fan of pharma. But I don't think your style of writing really helps. For example listing side effects without prevalence rates is somewhat misleading. For example I will take an aspirin despite the tiny possibility of a retinal bleed.

Lets assume that anti depressants are mostly placebo. The same can be said of psychology. The trick then is to come up with the most cost effective anti depressant. And I guess pharma winds hands down here.

This review shows that the long-term outcome for patients with mood disorders in the predrug era was reasonably positive. Most patients recovered and the majority seemed to remain well after their recovery. Comparisons with modern drug-treated cohorts are difficult due to methodological limitations. Nevertheless there are some consistent findings. The length of mood episode has decreased significantly from around 1 year to 1 month or less. Death rates, other than those due to suicide, have also reduced significantly. In contrast, the recurrence of mood episodes appears to have significantly increased. These data, to paraphrase Dickson and Kendell (1986), provide no comfort for those, including ourselves, who have believed that drugs provide an effective prophylactic treatment for at least a substantial minority of patients with affective disorders.

AND EARLIER IN THE DISCUSSION…

While surprising, our findings are consistent with the very few studies comparing the long-term outcome of mood disorders in the predrug and modern era. Ravn (1966) noted “strikingly few” readmissions among patients treated in a specific hospital prior to 1937 compared to those treated with ECT and drugs. Lenzi et al. (2008) using a small number of studies contrasted the “no-treatment era” with the “psychopharmacological era” and noted that the number of mood episodes has dramatically increased. Epidemiological studies have also reported that the use of drugs has not been associated with an improvement in the long-term outcome of mood disorders. Dickson and Kendell (1986) observed that between 1970 and 1981, when the use of lithium increased 10-fold, the rate of admissions for mania in Edinburgh trebled. Patten (2004) reported that increases in antidepressant use have been accompanied by an increased prevalence and duration of depressive episodes.

Hi there,
I don't think that depression is only or even primarily a chemical "imbalance," and I have suffered from depression throughout my life. Due to side effects (liver-related) I could not take meds when I was younger (back when there were only tricyclics). However, 15 years later I was able to take SSRIs and have been helped significantly by them. And the side effects really aren't that bad. I also see a therapist, and practice martial arts. All of these things are essential. These commercials you mention (we don't have them in Canada) do a great disservice to people's ability to see the full breadth of possibilities for healing and recovery. But your approach, referring only to the negative aspects of medications doesn't really help either.

This is a blog post about the power of labels. Here are some references if you want detailed information on what you asked for. As you can see, the benefits of drug therapies occur mostly in conjunction with psychotherapy:

Background Adherence to antidepressant medication use is a problem in clinical practice. Some authors have posited that combined psychological treatment facilitates adherence to pharmacotherapy.

Objectives To study the relationship between adherence to use of and efficacy of antidepressant drugs plus psychological treatment vs drug treatment alone in depressive disorders.

Data Sources MEDLINE, Current Contents, PsychInfo, Cochrane Library, and reference lists were searched, from January 1980 to November 2002.

Study Selection Randomized clinical trials comparing antidepressant treatment alone with antidepressant treatment in combination with a psychological intervention in depressive disorders were considered. The decision to include studies in the meta-analysis was performed by 2 reviewers.

Data Extraction Three independent reviewers extracted the data, using a precoded form. Methodological quality of the studies was evaluated in terms of allocation concealment and independence of evaluators.

Conclusions Psychological treatment combined with antidepressant therapy is associated with a higher improvement rate than drug treatment alone. In longer therapies, the addition of psychotherapy helps to keep patients in treatment. Further studies are needed to investigate whether the improvement in response attributable to the combination of drug treatment and psychotherapy can be achieved by a combination of pharmacotherapy and a compliance-enhancing intervention.

These data make sense only if the chemical imbalance model has holes in it.

There are plenty of articles about the benefits of drugs, the world doesn't need another one. This is the beauty of comments, you can ask for more information and I can provide it.

There are plenty of articles on the benefits of drugs, but a great many people refuse to take medications at all because of social stigma, and/or because they believe taking meds would be an indication that they are weak. Almost everyone I know who has suffered from depression has refused medication for a long time before finally trying it if they don't improve. I did this myself.

So despite the advertising and the promises of a silver bullet, a lot of folks aren't buying it. In the best of worlds, people would have access to a range of therapies and a lot of support to help them recover from depression, and perhaps medication would only be prescribed to a subset of depressed patients. But the reality is that many people can't afford to pay for therapy, and don't even know where to begin in terms of helping themselves. This needs to change.

In terms of side-effects, SSRIs are pretty mild. What about prednisone? Now there's a drug that'll kill you. Even aspirin can cause life-threatening bleeding. Acetaminophen can damage your liver.

Are you familiar with the work of Eero Castrén? He proposes a new theory for why/how antidepressants work (when they do) and why people benefit more if they are combined with another therapy: https://www.youtube.com/watch?v=WIXEq8NJBwA

Let me first say I agree with everything you say and there is research to back up the stigma issues.

I should probably state that I am not anti-drug. My position is that drugs on their own, and having a psychiatrist on prescription granting psychologist, just dispense is not the answer to emotional disorders. In combination with some of the things mentioned in other comments (psychotherapy, exercise, healthy eating habits, sunlight, increase in value-guided activities), we might have ourselves an effective treatment for an individual.

when 8-10% of depressed clients discontinue because of side effects for any treatment, as a clinical psychologist, I take notice. Especially when the pharmacotherapy side effects exacerbates the very symptoms of depression clients are coming in to seek treatment.

But yes, effectiveness and cost-effectiveness. People differ in what they are willing to take on. The benefit of treatments such as behavioral activation for depression is that there are no adverse reactions unless you want to count the natural anxiety that occurs when pursuing change.

I was talking to my husband about the research you mentioned in the article. He wondered what result you would get if you ran a fake test on the likelihood of psychotherapy being effective. I think he makes a good point - perhaps the research was exploring the importance of how a message is presented.

I still believe you did psychology a disservice by resorting to scare tactics in your article. A message like "90% of people don't experience side effects and that's typically only nausea" is totally different to a list of side effects without prevalence rates

A University of Liverpool researcher has shown that thoughts of suicide, sexual difficulties and emotional numbness as a result of anti-depressants may be more widespread than previously thought.

In a survey of 1,829 people who had been prescribed anti-depressants, the researchers found large numbers of people - over half in some cases - reporting on psychological problems due to their medication, which has led to growing concerns about the scale of the problem of over-prescription of these drugs.

Psychologist and lead researcher, Professor John Read from the University's Institute of Psychology, Health and Society, said: "The medicalisation of sadness and distress has reached bizarre levels. One in ten people in some countries are now prescribed antidepressants each year.

"While the biological side-effects of antidepressants, such as weight gain and nausea, are well documented, the psychological and interpersonal effects have been largely ignored or denied. They appear to be alarmingly common."

Each person completed an online questionnaire which asked about twenty adverse effects.

The study was carried out in New Zealand and all of the participants had been on anti-depressants in the last five years.

The survey factored in people's levels of depression and asked them to report on how they had felt while taking the medication.

Over half of people aged 18 to 25 in the study reported suicidal feelings and in the total sample there were large percentages of people suffering from 'sexual difficulties' (62%) and 'feeling emotionally numb' (60%).

Percentages for other effects included: 'feeling not like myself' (52%), 'reduction in positive feelings' (42%), 'caring less about others' (39%) and 'withdrawal effects' (55%). However, 82% reported that the drugs had helped alleviate their depression.

Professor Read concluded: "While the biological side-effects of antidepressants, such as weight gain and nausea, are well documented, psychological and interpersonal issues have been largely ignored or denied. They appear to be alarmingly common."

"Effects such as feeling emotionally numb and caring less about other people are of major concern. Our study also found that people are not being told about this when prescribed the drugs.

"Our finding that over a third of respondents reported suicidality 'as a result of taking the antidepressants' suggests that earlier studies may have underestimated the problem."

I suspect that most psychology professors might question the study you reference. They obviously didn't measure symptoms against a placebo. And there is the question of causation, particularly with the cohort sampled.

This probably reinforces other comments suggesting you might be selectively quoting research.

I wondered whether there had been any studies done comparing psychological therapies vs psychological therapies combined with pharmacotherapy therapy (the reverse of the above study you mentioned)?

I have a long history of recurrent depression and have been on and off anti-depressants for over a decade. I engage in regular therapy (based on ACT), exercise regularly and have created strong social supports/relationships to increase my wellbeing. I would prefer not to take anti-depressants (specifically for the sexual dysfunction side effects they cause) and had been off them for 2 years and I genuinely thought I had "beaten" depression.

However, I found myself spiralling into depression again last year when I unexpectedly fell pregnant with my third child. I avoided taking anti-depressants for 6 months and really amped up my therapy, plus attending positive psychology and mindfulness based courses, however I still found myself languishing. It wasn't until I reluctantly went on anti-depressants that I started to feel better and gain perspective. I decided I couldn't afford to be struggling so much with 3 children under 4 and wanted to be in the best frame of mind I could be!

I'd like to believe that the drugs effect is placebo as I'd rather not be on them. However, I really believed I could "beat" my depression with natural therapies, and gave it a good crack, but uItimately I couldn't.

When do you advocate the use of drugs? Once people reach a certain severity of depression is there evidence to say that chemical imbalance occurs?

I just wanted to say that I found what you said to be really interesting. I too have a history of depression, and was even hospitalized as a teenager for it. I was given a tricyclic (this was before the newer generations of meds). After a few weeks, I started to feel a lot better. Unfortunately, the tricyclics cause liver problems and the doctor had to stop the med. This lead to a terrible spiralling back into depression, and it seemed that nothing the doctor said or did made any difference for a very long time. Eventually I recovered, but experienced two more depressive episodes until in my early thirties, I started on yet another episode. At this point I went on an SSRI medication, and instead of being depressed for 6 months, I started to recover about 2 weeks after beginning the meds.

I found the med removed obstacles to my recovery - it reduced my tendency to ruminate, and for the first time, I realized that the rumination was not ABOUT anything - it was just low mood. It also eliminated panic attacks. With the help of meds I have gained a lot of knowledge about myself through psychotherapy, and I am working towards a black belt in Karate. I have also done CBT, which I also find helps.

As much as I would like to agree with those who say that meds are not the best choice, or that they are placebos, they really make a big difference to me. I still get depressed sometimes, but it is much easier to bear, because it is not as severe, and this, I think, makes the recovery process quicker and allows me to learn more from the experience.

I guess I'm saying I can relate to you, and I feel the same way. I am actually very grateful to be living in a time where we have begun to develop better meds and better alternative treatments.

You experience sounds almost identical to mine. My first episode with depression was when I was 19 and in my early 20's I was hospitalised with my worst and most severe depression. I have had another couple of episodes since then and am now 32 and at present feeling really well on meds.

My biggest problem was/is ruminating thoughts also. I have really found that meds have helped me enormously in gaining perspective and being able to disengage from these thoughts. I have found therapy, mindfulness and meditation much more effective when I am on meds also & have learnt a great deal about myself too. The effect is very profound and I can't believe it is just placebo. In fact as I'd rather not be on them and was a skeptic before taking them- my belief was that they wouldn't help.

It is uncanny how similar our experiences are!

Ultimately, I would like not to take meds (for the side effects I mentioned above), and will give it a go when my young children are a little older and I have the ability to do more things that increase my wellbeing (fitting in exercise, and my favourite pastime of surfing is possible but irregular at present due to breastfeeding, sleep deprivation etc.). However, I do feel grateful that meds work for me if I did need to take them again in the future.

Are you still taking meds?

Fantastic that you are right into martial arts and pursuing your black belt. Go for it!

I have taken medication since I was 32, and now I am 45. While it doesn't prevent depression, it makes it less severe and this helps me. And when I am well, it seems to eliminate the "hang-over" effects, like poor sleep, excessive rumination and anxiety attacks :-). Such fun.

As for the placebo argument, there is now research showing that antidepressants increase brain plasticity (at least in rats). In experiments, scientists were able to correct weakness in rats' eyes even though the rats were adults and would have lost the plasticity that their brains had in early life. https://www.youtube.com/watch?v=WIXEq8NJBwA
This may be why antidepressants help stroke patients so much. They are not placebos. It's too bad hat the whole discussion in the mainstream is reduced to whether or not you should take medication, which is really only one tool.

Good luck with raising your young kids! I have one, and he was born when I was 34. It is quite a bit easier when they are older and you can sleep more.

BTW, one other thing I do, is take some supplements - vitamin D, cal-mag-zinc and iron. I don't know if you've found taking vitamin or mineral supplements help?

If you feel like staying in touch, my blog is marchwinds.wordpress.com and my FB page is https://www.facebook.com/march.winds.31.

Many people with depression refuse to seek treatment because of the stigma, so thank you for sharing your story.

I wish there was an algorithm for when drugs should be used but there isn't. In fact, we are just starting to learn about the brain such that hopefully in the next 20 years physicians will be able to personalize medicine. That is, based on your neurobiology they will be able to pinpoint which anti depressant meds will be the most and least effective. Right now, its a crapshoot and the average person going under pharmacotherapy tries several drugs before one shows some effectiveness or they quit treatment.

For severe depression or anxiety, drugs can be a useful starting point for a person to begin engaging in healthy behavior. I have seen depressed clients who sleep 16 hours per day and the first step is to just have them wake up before 1pm and stay vertical, physically moving around for 30 minutes in the daytime for exercise. Those small steps often cannot be undertaken by someone in the depths of depression and thus, drugs can often be used to get some momentum. But drugs don't cure anything, they just mask the problem. This is why there is great benefit from combined psychotherapy and pharmacotherapy and then a tapering off of medication.

and here is a link to a free PDF of the article: http://www.thblack.com/links/RSD/BehavResTher2010_48_720_UseOfPsychotherapy.pdf

there are more questions than answers and its important to ask your therapist or physicians tons of questions, especially about why they are suggesting the current treatment being offered over all others. Come in with a list of treatments that show some efficacy to push the conversation forward.

Thanks for replying to my comment- it says a lot about your professionalism & passion that you take the time to respond to everyone's posts.

I have heard many people express the same sentiment as you in saying meds ultimately "don't cure anything" and just "mask the problem".

However, as I explained before- I have undertaken psychotherapy since I first became depressed and have implemented other treatment strategies to stay well such as exercising regularly, practicing mindfulness etc. And despite continuing with psychotherapy when I weaned off my meds (I have never ceased therapy), after a year or two without meds I became depressed again. This pattern has repeated itself 3 times over the last decade.

As I have said, I would love to not take meds and genuinely believed I had "cured" my depression this last time I was drugs free with my commitment to recovery attending therapy i.e. Getting to the root of the problem rather than masking it. I refused to go back on meds for 6 months following the onset of a depressive episode and increased my therapy sessions, attended courses (including one of your workshops at the Happiness conference in Melbourne last year which was fantastic) but ultimately I continued to struggle & reluctantly made the decision to take meds again. I resisted for so long as I felt I was a failure for not being able to do it without them.

Now that I am feeling well again, I view my decision as a no-brainer and am so happy I went back on them. I am a happier person, wife and mother and I now own my decision and am not ashamed of being on meds.

I guess I'm a little disappointed as I feel you are saying that ultimately (following treatment) you should be able to do it without meds. I understand that you are trying to empower people by proposing there is no real chemical imbalance, however the flip side is that for me, and people with a similar experience to mine, it's like saying we haven't tried hard enough to address the cause, or we are only benefitting from the placebo effect of meds.

Ali, thanks for all the kind words and for starting this conversation.

first off, it is fantastic that you beat your depression. second, you should not be ashamed for taking medication. third, my apologies if you feel I am inducing any shame with this blog post.

One of the things that I am hearing in your story is the wide variety of attempts to live a life on your terms. Those therapists that you worked with didn't do the hard work, they facilitated your hard work. When successful, medication can be viewed in the same benign way. The meds don't create well-being, they facilitate your ability to create a life that matters for you. Not only should you not be ashamed of taking meds, you should be proud of how you persevered to get through the depths despite obstacles and failures along the way. This grittiness is what every parent hopes to cultivate in their children and what every human being hopes is available when difficult times arise.

One of the not so hidden secrets in psychology/psychiatry is that nobody knows which treatment will work for whom under what conditions and if it does work, why. For some people, paxil has an effect, for other people it exacerbates their anxious and depressive symptoms and for others it is inert, and the same unpredictable pattern holds for every psychotropic medication. And we simply do not have the knowledge at present to understand these divergent reactions to the same treatment. When we do, this will signal the era of personalized medicine.

No therapist or chemical can take full credit for what you have accomplished. It is your willingness to keep moving forward toward what you care about despite the presence of pain. If treatment helps facilitate this, excellent.

Thanks for responding to my thoughts with such respect and sensitivity Todd.

Your words of encouragement were received with great warmth and forced me to take stock of the work I have done and you are right- that is something to be proud of.

I loved the way you framed anti-depressants and therapy as both being facilitators of recovery, rather than the driving force. Like you say- that can only come from the individual, but is definitely something I haven't given myself much credit for. As I imagine is that case with many others too.

I could only read the first few paragraphs and the list of side effects before I started laughing. SO, are we to assume the our clinical depression and chemical imbalances are all in our imaginations and that these drugs do not have any positive effects? I just love doctors and their opinions and their love of chemical cocktails. As a bipolar suffer, I find some of these discussions hilarious if you haven't been looking out through my eyes. Excuse me, I have to go take my placebos now before this spins me out of control!

Its okay for you to disagree.
You might want to check out some of the responses I gave to other people who left comments. You will find that I am not anti-chemistry.

Nobody said anything about depression being in your imagination. This is about whether or not it is purely a chemical phenomena that can be fully treated by a chemical treatment. This is about the cost of attaching yourself to the label of having a psychological condition that is a "ghost in the machine" that only requires neural rewiring.

I have spent much of my career conducting research and treatment on people suffering from anxiety and depressive disorders. While I do not know your unique perspective, I have learned quite about about these conditions and how to treat them. That is because of decades of scientific research that is available. My only goal is to distill a bit of that here.

I believe that the chemical company are the cause of all this suffering and are able to sale more chemical to try to fixe what they themself cause to begin with, going 100% organic remove all toxin from your body and brain. Life can then flourish inside of you and your brain is then able to focus, many children with HADD when put on an organic diet return to being normal kids. The same for all of us. Chemicals are use every where, to grow our food to preserve our food in the process of our food, in the water we drink in the air we breath. Take all these chemical shake well and watch people explode. More chemical is not the answer.

Todd - from the discussion it seems that anti depressanst do have a place. Until appropriate algorithms are developed (as you suggest) and given that our knowledge of when to use psychotherapy is just as vague, and given healthcare costs are balooning, it would seem reasonable that given the cost effectivness of meds, that they are probably the best first line of treatment.

Re the study you quote in the article I assume it hasn't been replcated. We all should aboid the urge to jump on the band wagon unitil science has run its course.

Its also probably useful to rememember the issue of branding as it applies to psychology. Psychologists push meaning knowing that there are no proven interventions and that people who search for meaning experience substantially less life satisfaction. Perhaps psychology parallels anti depressants in this regard?

Todd - i'm not sure why you are referencing benzo's when SSRI's are the preferred treatment protocol for most forms of depression. The comparison is really chalk and cheese given the addictive nature of benzo's and the associated withdrawal symptoms.

Do you have any research supporting that psychotherapy has a benefit over meds on the treatment of depression. Perhaps lower relapse rates??

I have recently has a mild shoulder injury - I resisted getting a cortisone shot mainly due to concerns about side effects. Eventually I had the needle and it worked wonderfully. The doctor who performed the procedure explained that the cortisone will stop the inflammatory response and allow the body to heal - it doesn't do the healing (exactly what you suggested)

So perhaps that is what anti depressants do particularly for mild to moderate depression. They allow you to get on with things and heal yourself - and you probably don't even need a psychologist.

The story might be different for severe depression or comorbity where combined therapy might be best.

But either way drugs are probabl the appropriate starting point given their cost effectivness. If they don't work then bringing other treatments in wold seem appropriate.

A new study reinforces the point about knowing when to use meds, drugs and other potentially more effective interventions. Psychology has to be really cautious about throwing stones when its own backyard isn't exactly squeaky clean.

Discussions with a dietary coach to learn about healthy eating were as effective as meeting with a counselor for problem-solving or "talk" therapy in preventing major depression among older black and white adults with mild symptoms of the mood disorder, according to researchers at the University of Pittsburgh and the University of Maryland.

Mr Kashdan is probably wealthy enough to afford psychotherapy. Unfortunately I am not in that position. Meds worked quickly for me and the only side effect I had was a little nausea which I quickly got over. I only took the for a short period of time while I got through a difficult time in my life.

My sister was reluctant to use meds and tried various alternatives including different types of psychology. None of this worked and reluctantly she tried SSRI's. She is a new woman.

So like many people above meds did work.

If psychology did work and was as cheap as pharmaceuticals then perhaps I would consider it. But there are those of us in the real world who don't have alot of money and need to get on with our lives.

I wish I was a well paid university lecturer. Then I would have the income to afford psychotherapy. Unfortunately its a choice between feeding my kids and seeing a psychologist. Thank god meds work for me.

I have been a life-long sufferer of severe depression and anxiety myself. Has anyone thought that perhaps the medication that they feel is finally helping them after trying so many that didn't seem to work may be due to the possibility that the medication is really working like a placebo and the one that finally seems to be helping just happens to be the one that presents the least amount of side effects combined with that particular persons body chemistry? Also, keep in mind that once on these drugs for a while, the brains chemistry is tampered with and sometimes irreparably, depending on the amount of time the person has taken the medication. Of course the person thinks medication is helping them after the medication they were on before had such undesirable effects. So many people swear by their medications effectiveness so this would explain why some medications didn't help while one in particular seems to. I have learned to live a fulfilling an happy life without medication, after trying SO many. The way I've done this has been by sustaining myself on a healthy diet (with little to no meat), being physically active, often while getting a good amount of sunlight and by surrounding myself with a supportive and loving group of people. I have my moments, but don't we all? Yes, Mine may be worse than those of a "normal" persons but I do not buy into the money-making scheme of the pharmaceutical companies and so-called doctors. They have done nothing but try to convince me that I can do nothing without them. Well, I have definitely proven them wrong.

Yes! I am saying I can create depression with a simple experiment for anyone who can perform my demonstration of subliminal sight and habituation in peripheral vision. It is linked at the top of my home page, and shows the ability to ignore movement in peripheral vision, suppress the vision startle reflex. (Those who cannot do that cannot have Subliminal Distraction exposure and are immune from it. This explains why mental illness seems to run in families. That ability is inherited.)

Fifty years ago engineers discovered a previously unknown problem with human physiology when it caused mental breaks for office workers,1964. The office cubicle was designed to block peripheral vision to stop believe-harmless episodes of psychotic-like confusion by 1968.

When it happened to my wife after her office was changed eliminating Cubicle Level Protection, she heard voices and had depressive crying episodes concerning guilt for impossible criminal situations she hallucinated. Her Subliminal Distraction episode was mistaken for schizophrenia. I had known of the problem since I was a 22 year old engineering student in 1966 but had never seen it happen before. (See her hospital records on site.)

I eventually learned that psychiatrists are unaware engineers ever found or solved the problem. I began a project to find out why the simple problem is unknown in mental health services, VisionAndPsychosis.Net.

The subliminal appreciation of threat from subliminal failed attempts to startle is defined in first semester psychology as a visual subliminal distraction. The engineering design problem take the same name, Subliminal Distraction.

But if the mental break it is known to cause is mentioned in lectures on peripheral vision reflexes, it is treated as something that happened once, long ago, not a normal feature of everyone's physiology of sight. My instructor said, "Subliminal sight caused a problem in the early days of modern office design." The quality of psychology courses is so poor across the country that you may have to find someone to dig the information out of lecture material on peripheral vision reflexes.

You can use the Wayback Machine to show my project began in the fall of 2002. There is a link at the bottom of my Home page to a forum post where I was accused of being an attorney trying to get information for a lawsuit. That post shows that designers and engineers eschew discussing Subliminal Distraction. No one wants to make the career ending mistake of revealing information that would start a flood of lawsuits against an employer or customer.

Herman Miller, Steelcase, Knoll, and Haworth have sold cubicles and designed open plan offices using "Systems Furniture" for almost fifty years to prevent a problem they believe is harmless and only happens in incorrectly designed, large, crowded business offices. It's a problem of everyone's physiology of sight not offices. Modern close-spaced offices were the first place all the "special circumstances" were created and observed to discover it. It has always existed to cause psychiatric symptoms through history. (See my Culture Bound Syndromes page.)

Understand, engineers did not caused the problem, they created the situation that revealed it exists. Reports of spontaneous remissions in scholarly books on the history of mental illness show, unrealized by the authors, that Subliminal Distraction filled mad houses in London 400 years ago. There were no drugs then so all recoveries were spontaneous remissions. Where are those remissions today? Mental illness has not changed. Spontaneous remissions are being covered up by immediate treatment and claimed as outcomes for failed drugs and nonsense talk therapy solutions. When exposure stops and symptoms remit doctors and patients believe the last drug or treatment modality caused the recovery.

By replicating the situation engineers discovered I can cause depression, the first outcome of Subliminal Distraction exposure. Panic attacks are another common outcome. The experiment is safe if all the precautions are taken to stop the experiment when the first subtle thought changes are recognized.

Today computers require the same level of mental investment as office work. That allows the mental break causing design mistake to be made almost anywhere. I believe this is the long sought cause of college suicides when students make the design mistake where they study or use a computer. Exposure would peak at times of intense study such as midterms and finals. That's when college students begin to vanish and commit suicide. (See my College Suicides page.)

There is no treatment for Subliminal Distraction episodes. They must spontaneously remit when exposure stops. My guess as to why the mental break happens is on the "Background" section of my "Site Outline" page. I have been unable to find anyone in neurology or psychiatry to explain what happens in the brain from a massive number of subliminal failed attempts to startle to cause a psychotic-like episode.

Everyone with a computer at home or a child in school should be aware of the problem to take simple free precautions to avoid exposure.

You are either smart enough to take free advice and provable information or you are not. VisionAndPsychosis.Net

This is a very important article and should stimulate a lot of discussion in many places. Unfortunately, it is way too brief. Two things I wish it included are the term "nocebo effect" (which it otherwise references by example) and the idea that our brain chemical levels can be influenced by a variety of things we choose to do or not do. We are not helpless victims of brain chemistry but rather artistic mad scientists living 24/7 in a Universal laboratory. If you doubt that, have your doctor or therapist write a referral for hypnotherapy and I'll help you discover this through your own experience.

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Dear Sir, I fail to see any sign that you have any first hand experience with what I'll call internal depression, a situation where there are no external forces that might make one feel depressed. As one who had suffered from depression starting at the age of 10, and after 20 years managed to design a life nearly symptom free I am trying not to feel anger toward this article. Sure, the pharmaceutical companies love the art of misdiagnosing and their drugs may even do more harm than good but to put "chemical imbalances and myth" in the same sentence is unprofessional and a little ignorant. It does make a good headline I guess considering you are into the self help/positive thinking industry. Yet god forbid some poor kid get a reads it and can put further blame on himself, pushing him further down that downward spiral. But from what I see, you wouldn't know anything about that. you'd know that it just isn't there. You can't say "oh, yeah everythings great" when they don't even know why they are feeling bad. Yes, exercise, diet, atmosphere are very important, as well are a supportive environment. BUT, the chemical imbalances are fact. How can I prove it. Season Affective Disorder, where external conditions effect brain chemistry and in turn mood. Science that I think stands on firmer grounding than the art of thinking positive. Hell, I moved to Florida specifically to get more sunlight so I could get off medications and it worked like a charm in improving the condition and allowing me to get off the drug. There are also theories where as one grows older the brain produces less melatonin...basically, the science is there and if find such articles as this are just as harmful as the pharmaceutical companies behavior. To say it's a myth and everyone who has benefited from the medications is due to a placebo effect comes off as a statement from someone who thinks they are superior being smug. All depressed people do is examine themselves. They don't know what is wrong and they constantly blame themselves and try different things to get out of the funk. You act as if they don't, that you have the ability to see into other minds and judge. I'd keep to your self improvement crowd and stay away from those with depression issues, in fact stay away from the subject, all you will do is cause harm. I am trying to respect you article, and be polite, but to make across the board declarations on depression. I think you have to do more research and reconsider your position. But from coming from someone who got out of it mostly due to the same ways you would promote, I would never assume how another persons mind works or damn any method that has helped people. Not one of the worse things, but maybe most irritating things about depression are those on the outside making comments on the subject they know nothing about.

Thank you for saying what you did. I have a chemical imbalance that has plagued me for far too long. At 48, almost 49, I just recently found out that all but 2 of the chemicals were we below normal and the other 2 were above average. After years of different meds (that never did more than keep me from going over the edge) and therapy and wondering why in the hell the meds didn't do much, I now feel validated due to the results of this testing. With that said, I am seeking alternative methods of help such as supplements and transcranial therapy (not ECT, but similar and less invasive). I feel like a whole new road has opened up for me. I feel like hell right now as I've just started this part of the journey, but at least I have a new path to travel. I am also seeking therapy with someone very knowledgeable on CBT as I do believe that will help as well. I think the guy who wrote this is on crack based on his statements.
Thanks again. I wish you well.